What is the role of chest X-ray in the initial assessment of stable trauma patients?

J Trauma. 2007 Jan;62(1):74-8; discussion 78-9. doi: 10.1097/01.ta.0000251422.53368.a3.


Background: The Advanced Trauma Life Support course advocates the liberal use of chest X-ray (CXR) during the initial evaluation of trauma patients. We reviewed CXR performed in the trauma resuscitation room (TR) to determine its usefulness.

Methods: A retrospective, registry-based review was conducted and included 1,000 consecutive trauma patients who underwent CXR in the TR at a Level I trauma center during a 7-month period.

Results: Patients receiving CXR comprised 91.5% of all patients evaluated in the TR during the study period. CXR followed by chest computed tomography (CCT) was performed in 820 (82.0%) patients. Subsequent CCT identified missed findings in 235 (35.6%) of the 660 patients with an initial negative CXR who went on to receive CCT. CXR alone was performed in 127 (26.1%) of the 487 patients who were stable, not intubated, and had a normal chest physical examination (CPE). Seven patients (5.5%) in this group had potentially significant findings but none required intervention beyond physiotherapy or antibiotics. Three hundred and sixty (73.9%) of the 487 patients who were hemodynamically stable with a normal CPE underwent both CXR and CCT. Fifty-four patients (15%) in this group had findings of significance, and two (0.6%) required intervention. One patient received bilateral chest tubes for large pre-existing pleural effusions found on CXR and CCT; another patient undergoing general anesthesia required a chest tube for a pneumothorax found only on CCT.

Conclusion: In stable trauma patients with a normal CPE, CXR appears to be unnecessary in their initial evaluation. CXR should be relegated to a role similar to cervical spine and pelvis radiographs in the initial evaluation of hemodynamically stable trauma patients with a normal physical examination, and should be limited to use only for clear clinical indications.

MeSH terms

  • Adult
  • California
  • Cost-Benefit Analysis
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Male
  • Physical Examination
  • Practice Guidelines as Topic
  • Radiography, Thoracic* / economics
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Wounds and Injuries / diagnostic imaging*
  • Wounds and Injuries / economics